Pulse oximetry as a fifth vital sign in emergency geriatric assessment.

OBJECTIVE: To determine the utility of pulse oximetry as a routine fifth vital sign in emergency geriatric assessment. METHODS: Prospective study using pulse oximetry to measure O2 saturation in geriatric patients presenting to ED triage. Saturation values were disclosed to clinicians only after they had completed medical evaluations and were ready to release or admit each patient. The authors measured changes in medical management and diagnoses initiated after the disclosure of pulse oximetry values. The study included 1,963 consecutive adults aged > or = 65 years presenting to triage at a university ED. Measurements included changes in select diagnostic tests: chest radiography, complete blood count (CBC), spirometry, arterial blood gases (ABGs), pulse oximetry, and ventilation-perfusion scans; treatments: antibiotics, beta-agonists, and supplemental O2; and hospital admission and final diagnoses that occurred after complete ED evaluation when physicians were informed of triage pulse oximetry values. RESULTS: 397 (20.2%) geriatric patients had triage pulse oximetry values <95%. Physicians ordered repeat oximetry for 51 patients, additional chest radiography for 23, CBC for 16, ABGs for 15, spirometry for 5, and ventilation-perfusion scans for none. Physicians ordered 49 new therapies for 44 patients, including antibiotics for 14, supplemental O2 for 29, and beta-agonists for 6. Nine patients initially scheduled for ED release were subsequently admitted to the hospital. Physicians changed or added diagnoses for 27 patients. CONCLUSIONS: Using pulse oximetry as a routine fifth vital sign resulted in important changes in the diagnoses and treatments of a small proportion of emergency geriatric patients.

Pulse oximetry as a fifth pediatric vital sign.

PURPOSE: To determine the utility of pulse oximetry as a routine fifth vital sign in acute pediatric assessment. DESIGN: Prospective study using pulse oximetry to measure oxygen saturation in children presenting to emergency department triage. Saturation values were disclosed to clinicians only after they had completed medical evaluations and were ready to discharge or admit each child. We measured changes in medical treatment and diagnoses initiated after the disclosure of pulse oximetry values. SETTING AND PARTICIPANTS: The study included 2127 consecutive children presenting to triage at a university emergency department. MEASUREMENTS: Changes in select diagnostic tests: chest radiography, complete blood count, spirometry, arterial blood gases, pulse oximetry, and ventilation-perfusion scans; treatments: antibiotics, beta-agonists, supplemental oxygen; and hospital admission and final diagnoses that occurred after disclosure of triage pulse oximetry values. RESULTS: Of 305 children having triage pulse oximetry values less than 95%, physicians ordered second oximetry for 49, additional chest radiography for 16, complete blood counts for 7, arterial blood gas measurements for 4, spirometry for 2, and ventilation-perfusion scans for 2. Physicians ordered 39 new therapies for 33 patients, including antibiotics for 15, supplemental oxygen for 11, and beta-agonists for 8. Five patients initially scheduled for hospital discharge were subsequently admitted. Physicians changed or added diagnoses in 25 patients. CONCLUSIONS: Using pulse oximetry as a routine fifth vital sign resulted in important changes in the treatment of a small proportion of pediatric patients.

A comparison of pulse oximetry and respiratory rate in patient screening.

OBJECTIVE: To examine how well respiratory rate correlates with arterial oxygen saturation status as measured by pulse oximetry, and determine whether respiratory rate measurements detect oxygen desaturation reliably. METHODS: Respiratory rate (RR) and oxygen saturation (SaO2) were measured prospectively on 12,096 consecutive adult emergency department triage patients at a university medical center. Respiratory rate was measured by counting ausculated breath sounds for 1 min. Pulse oximetry was used to measure SaO2. Measurements were analysed by age (with one group for 18-19 year olds, groups for every 10 yr from age 20 to age 60, and groups for every 5 yr for subsequent ages). Pearson correlation coefficients were calculated for each age group as well as the weighted average coefficient. Cases having oxygen saturation below 90% were examined to determine how frequently they exhibited increased RR (increased RRs were defined as any rate in the upper five percentile by age. RESULTS: Correlation coefficients ranged from 0.379 to -0.465 with a weighted mean of -0.160. Coefficients for ages 18 through 70 years (representing 10,740 patients) all had magnitude < 0.252. Overall, only 33% of subjects with oxygen saturation below 90% exhibited increased RR. CONCLUSIONS: Respiratory rate measurements correlate poorly with oxygen saturation measurements and do not screen reliably for desaturation. Patients with low SaO2 do not usually exhibit increased RR. Similarly, increased RR is unlikely to reflect desaturation.

Effect of routine emergency department triage pulse oximetry screening on medical management.

PURPOSE: To determine the utility of routine triage pulse oximetry screening in emergency department (ED) patients. DESIGN: Prospective study using pulse oximetry to measure oxygen saturation of ED patients at triage. Saturation values were disclosed to physicians only after they completed medical evaluations and were ready to discharge or admit each patient. We measured changes in medical management initiated after disclosure of pulse oximetry values. SETTING AND PARTICIPANTS: The study included 14,059 consecutive patients presenting to triage at a university ED. MEASUREMENTS: Changes in select diagnostic tests: chest radiography, CBC count, spirometry, arterial blood gases, pulse oximetry, and ventilation-perfusion scans; treatments: antibiotics, beta-agonists, supplemental oxygen; and hospital admission and final diagnoses that occurred after disclosure of triage pulse oximetry values. RESULTS: Of 1,175 patients having triage pulse oximetry values less than 95%, physicians ordered repeat pulse oximetry on 159 (13.5%), additional chest radiography on 5.4%, CBC count on 3.1%, arterial blood gases on 2.9%, spirometry on 0.9%, and ventilation-perfusion scans on 0.3%. Physicians ordered 178 new therapies on 134 patients (11.4%), including supplemental oxygen for 6.5%, antibiotics for 3.9%, and beta-agonists for 1.8%. Thirty-five patients (3.0%) initially scheduled for hospital discharge were subsequently admitted. Physicians changed or added diagnoses in 77 patients (6.6%). CONCLUSIONS: Providing physicians with routine triage pulse oximetry measurements resulted in significant changes in medical treatment of these patients.